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Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales.
Vaccine. 2004 Oct 22; 22(31-32):4203-14.V

Abstract

AIM

To establish whether universal vaccination of infants with the pneumococcal conjugate vaccine is likely to be cost-effective from the perspective of the health care provider (NHS).

METHOD

Two hypothetical cohorts--one vaccinated and one unvaccinated--were followed over their lifetime, and the expected net costs and benefits (measured in terms of life-years and quality adjusted life years (QALY) gained) were compared in the two cohorts. The impact of indirect effects of the vaccine, such as herd immunity and serotype replacement, were investigated and their relative importance was assessed by performing univariate sensitivity analysis and multivariate Monte Carlo simulations.

RESULTS

Under base-case assumptions (no herd immunity and no serotype replacement) the programme is not expected to be cost-effective from the NHS perspective at the current price of the vaccine (assumed 30 pounds per dose, three-dose programme). A reduction of the cost of the vaccine to half of its current level could bring the cost per QALY gained within normally acceptable ranges. If the burden of disease is significantly underestimated by current surveillance systems, then the cost per QALY gained approaches acceptable levels at the current vaccine price. Herd immunity may substantially reduce the burden of pneumococcal disease, particularly of pneumonia among the elderly, leading to a significant improvement in the cost per life year and QALY gained. Serotype replacement would partly offset these benefits, although only with a complete substitution of vaccine types with non-vaccine types and a low level of herd immunity, would pneumococcal vaccination programme would not be cost-effective.

CONCLUSIONS

Conclusions on the cost-effectiveness of pneumococcal conjugate vaccine are sensitive to assumptions regarding the current burden of pneumococcal disease and the future impact that vaccination will have in the unvaccinated and on the future serotype distribution. This study quantifies, for the first time, how these indirect effects may change the cost-effectiveness of pneumococcal vaccination.

Authors+Show Affiliations

Modelling and Economics Unit, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK. alessia.melegaro@hpa.org.ukNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15474710

Citation

Melegaro, A, and W J. Edmunds. "Cost-effectiveness Analysis of Pneumococcal Conjugate Vaccination in England and Wales." Vaccine, vol. 22, no. 31-32, 2004, pp. 4203-14.
Melegaro A, Edmunds WJ. Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales. Vaccine. 2004;22(31-32):4203-14.
Melegaro, A., & Edmunds, W. J. (2004). Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales. Vaccine, 22(31-32), 4203-14.
Melegaro A, Edmunds WJ. Cost-effectiveness Analysis of Pneumococcal Conjugate Vaccination in England and Wales. Vaccine. 2004 Oct 22;22(31-32):4203-14. PubMed PMID: 15474710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness analysis of pneumococcal conjugate vaccination in England and Wales. AU - Melegaro,A, AU - Edmunds,W J, PY - 2004/02/11/received PY - 2004/05/04/accepted PY - 2004/10/12/pubmed PY - 2004/12/28/medline PY - 2004/10/12/entrez SP - 4203 EP - 14 JF - Vaccine JO - Vaccine VL - 22 IS - 31-32 N2 - AIM: To establish whether universal vaccination of infants with the pneumococcal conjugate vaccine is likely to be cost-effective from the perspective of the health care provider (NHS). METHOD: Two hypothetical cohorts--one vaccinated and one unvaccinated--were followed over their lifetime, and the expected net costs and benefits (measured in terms of life-years and quality adjusted life years (QALY) gained) were compared in the two cohorts. The impact of indirect effects of the vaccine, such as herd immunity and serotype replacement, were investigated and their relative importance was assessed by performing univariate sensitivity analysis and multivariate Monte Carlo simulations. RESULTS: Under base-case assumptions (no herd immunity and no serotype replacement) the programme is not expected to be cost-effective from the NHS perspective at the current price of the vaccine (assumed 30 pounds per dose, three-dose programme). A reduction of the cost of the vaccine to half of its current level could bring the cost per QALY gained within normally acceptable ranges. If the burden of disease is significantly underestimated by current surveillance systems, then the cost per QALY gained approaches acceptable levels at the current vaccine price. Herd immunity may substantially reduce the burden of pneumococcal disease, particularly of pneumonia among the elderly, leading to a significant improvement in the cost per life year and QALY gained. Serotype replacement would partly offset these benefits, although only with a complete substitution of vaccine types with non-vaccine types and a low level of herd immunity, would pneumococcal vaccination programme would not be cost-effective. CONCLUSIONS: Conclusions on the cost-effectiveness of pneumococcal conjugate vaccine are sensitive to assumptions regarding the current burden of pneumococcal disease and the future impact that vaccination will have in the unvaccinated and on the future serotype distribution. This study quantifies, for the first time, how these indirect effects may change the cost-effectiveness of pneumococcal vaccination. SN - 0264-410X UR - https://www.unboundmedicine.com/medline/citation/15474710/Cost_effectiveness_analysis_of_pneumococcal_conjugate_vaccination_in_England_and_Wales_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(04)00380-9 DB - PRIME DP - Unbound Medicine ER -